Obtaining concomitant control of allergic rhinitis and asthma with a nasally inhaled corticosteroid

Abstract

Allergic rhinitis (AR) and asthma coexist frequently and a dual treatment is recommended by prescribing topical nasal plus oral inhaled corticosteroids. The purpose of this study was to assess the efficacy of a nasally inhaled corticosteroid aiming at concomitant control of AR and asthma. A controlled trial was conducted among 60 patients with AR and asthma, aged 6-18 years, who were randomized into two groups. During 8 weeks, the experimental group (30 patients) received exclusively fluticasone propionate hydrofluoroalkane (FP-HFA) inhaled through the nose (mouth closed) using a large volume spacer attached to a face mask. The comparison group (30 patients) received a nasal spray of isotonic saline plus oral inhalation of FP-HFA through a mouthpiece attached to the same spacer. Clinical scores for AR and asthma, nasal inspiratory peak flow (NIPF), and spirometry were assessed by blinded observers. There was a significant improvement in AR scores and NIPF in the experimental group (P <or= 0.01) up to week 8, when a worsening was observed after the intervention was interrupted. Asthma symptoms score, forced expiratory volume (FEV)(1), and FEF(25-75%) were not statistically different between groups at the baseline visit or along follow-up visits (P >or= 0.20). Prebronchodilator FEV(1) (% predicted value) improved by 10% in both groups, comparing values at inclusion with those obtained at the end of follow up. Our results suggest that nasally inhaled FP-HFA through a spacer may control AR and asthma in children and adolescents. This approach is likely to result in higher compliance, lower costs, and fewer side effects.

Pediatric Allergic Rhinitis and Asthma: Can the March be Halted?

“…Since intranasal corticosteroids have not been shown to result in significant deposition to the lungs, the reduction in asthma symptoms may be related to improvements in nasal function rather than any direct effects of the medication on the lower airway [63]. Meanwhile, studies in children and adolescents demonstrate an efficient control on AR and asthma symptoms by simultaneous treatment with intranasally inhaled corticosteroids (budesonide [64], beclomethasone [65], fluticasone [66,67]). Less is known about the effects on nasal disease of inhaled (intrabronchial) corticosteroid treatment [1].…”

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Symptoms and pulmonary function tests were inconstantly improved. However, a number of aspects, such as the extent to which the pathophysiology of the two diseases overlaps and whether treating one will affect the other, still remain to be clarified (2025).…”

Author's response: allergic rhinitis and asthma require an integrated management

“…The latter group also received 0.9% sodium chloride intranasal spray. 3 Although asthma clinical score, forced expiratory volume in 1's, allergic rhinitis symptom score and nasal inspiratory peak flow improved in both groups from baseline, no statistically significant difference was found between the two treatment groups, except for rhinitis symptom score and nasal inspiratory peakflow at 8 weeks in favour of the experimental group (p<0.001 and p=0.008). Because all patients were steroid naive, treatment with inhaled corticosteroids could be expected to produce improvements in both groups.…”